morteza gharavi

 Defense mechanisms are essential to personality and behavior that help individuals deal with stress. These mechanisms might act in different ways, rendering medical students caring physicians or egoistic individuals, and thus, a good understanding of defense mechanisms can contribute to the efforts made to improve the psychological well-being of medical students.

 We studied the prevalence of generalized anxiety disorder (GAD) and alexithymia as determinants of psychological well-being and the mechanisms by which medical students might cope with stress and anxiety.

 The present cross-sectional study was conducted on 232 medical students, 126 (60%) females and 96 (40%) males, in northeast Iran. Data were collected through GAD-7, the Farsi version of the Toronto Alexithymia Scale (FTAS-20), and the Defense Styles Questionnaire (DSQ-40). Statistical analysis was performed with IBM SPSS 22.0. Pearson's chi-square test, bivariate correlations, and multiple linear regression analysis were used to identify associations between GAD, alexithymia, and defense mechanisms.

 A total of 87 (37.5%) participants showed moderate to severe anxiety. Alexithymia was detected in 49 (21%) participants. Mature defense mechanisms had the highest prevalence among participants (56.5%), while immature mechanisms had the least (23.3%). A significant positive correlation was noted between GAD and alexithymia. Also, GAD was positively correlated with immature and neurotic defense mechanisms (P < 0.05). A negative correlation was found between mature defense mechanisms and GAD (P < 0.001). Suppression and humor (mature mechanisms) were the negative predictors of GAD. Reaction formation, somatization, autistic fantasy, splitting, passive aggression, displacement, and pseudo-altruism (an immature and neurotic mechanism) were the positive predictors of GAD.

 The statistically significant correlations found among GAD, alexithymia, and defense mechanisms suggest that a good understanding of these conditions and mechanisms can contribute to alleviating anxiety among medical students and improving their psychological well-being.

As a complex phenomenon, menopause is accompanied by simultaneous biological, psychic and social changes in life. Attachment styles have critical role in determining the way a woman behave to her body. Researches have shown that there is a relation between unsecure attachment and somatization. They are more vulnerable and tolerate more anxiety. Most of them use psychical mechanism to reduce their anxiety. Moreover, reduction of sexual desire is one of the widespread symptoms of menopause that is related to attachment styles, too. Sex guiltiness is the most important reason of reduction in sexual desire in women and it is related to somatization. Therefore, this study was conducted to investigate the relation between severity of menopausal symptoms with attachment styles based on the mediation role of defense mechanism and sex guiltiness feel. 

According to Morgan table, 388 individuals was participated to study, menopause women ranging from 45 to 65 years old in the city of Mashhad (Khorasan Razavi province, Northeast of Iran). They were selected by using convenience sampling. Inclusion criteria included to be in menopausal period, consent to participate in research, between 45 to 65 years old, Mashhad inhabitant, at least elementary literacy, no background of chronic psychical or physical disease, hysterectomy or artificial menopause and not using replacement therapy like hormone therapy. For data collection, different questionnaire including that of Greene questionnaire of severity of menopausal symptoms, Hazan and Shaver's adult attachment style, Andrews' defense style and Mosher's sex guilt were used. These questionnaires were spread in parks and recreation centers of five main districts of Mashhad. Mean, standard deviation and Pearson correlation accounted by the use of SPSS Ver.21 and data were analyzed by using path analysis in Lisrel software.  

Correlation between severity of menopausal symptoms, attachment styles, defense mechanisms and sex guilt were significant (p<0.01). In another words, with an increase in severity score of menopausal symptoms, participant’s scores in sex guilt, immature and neurotic defense mechanism, avoidant, and ambivalence attachment styles were augmented. Fitness parameters of path analysis indicated that the model was generally fitted. The results of path analysis also showed that insecure attachment styles (avoidant and ambivalent) through sex guilt, immature and neurotic defense mechanism, can affect the severity of menopausal symptoms. The effect of avoidant attachment on severity of menopausal symptoms was 0.23, through sex guiltiness feel was 0.26 and through immature and neurotic defense mechanism was 0.24 and they were significant (p<0.01). The effect of ambivalent attachment on severity of menopausal symptoms was 0.18, through sex guilt was 0.21 and through immature and neurotic defense mechanism was 0.20 and they were significant, too (p<0.01). Women with avoidant or ambivalent attachments experience more severe symptoms. In addition, women with high score in menopausal symptoms scale, have higher score in immature and neurotic defense mechanism and sex guilt. 

According to findings, conceptual model of the research confirmed and the results of path analysis, indicated that insecure attachment styles (avoidant and ambivalence) with more sex guilt and by the use of immature and neurotic defense mechanisms, affect the severity of menopausal symptoms. Thus, effects and relations of attachment styles on the severity of menopausal symptoms are mediated by sex guilt and defense mechanism. Insecure women experience more anxiety, therefore they use more immature and neurotic defense mechanism that it results in the increase of severity of menopausal symptoms. Moreover, when women feel sexual guilt, it also may cause the increase in severity of menopausal symptoms.